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Hi Dr. Kumar: I'm Wondering If You Have Any Experience
Question: Hi Dr. Kumar:
I'm wondering if you have any experience treating PTSD/bipolar/borderline patients using topiramate. My doctor and I were looking at options in this class he thought it might be helpful with symptoms like racing thoughts, rage, detachment, interpersonal sensitivity, and occasional hypomania
He wrote a script but didn't give any indication how it would fit in my current regimen of 100 mgs lamictal and 15mgs celexa. Would you simply add it on or replace one of the other medications. I can't currently raise the dose of either without bad side effects, nor can I take them at the same time of day.
I'm wondering if you have any experience treating PTSD/bipolar/borderline patients using topiramate. My doctor and I were looking at options in this class he thought it might be helpful with symptoms like racing thoughts, rage, detachment, interpersonal sensitivity, and occasional hypomania
He wrote a script but didn't give any indication how it would fit in my current regimen of 100 mgs lamictal and 15mgs celexa. Would you simply add it on or replace one of the other medications. I can't currently raise the dose of either without bad side effects, nor can I take them at the same time of day.
Brief Answer:
consultation
Detailed Answer:
Hello,
Thanks gain for follow up.
I am sorry to inform you that I never used topiramate for PTSD or borderline patients but well experienced with use of topiramate in treatment of bipolar disorder/mania.
Nevertheless I opine that it is quite useful for racing of thoughts, negative feelings, intrusive thoughts and interpersonal sensitivity as per my experience and available data (although limited).
In regard to placing this new agent in treatment regimen I like to decrease dose of Celexa to 10 mg and add Topiramate 25 mg per day at the initiation, provided I was your treating psychiatrist. I would like to raise topiramate to 100-300 mg depending on the response and side effects.
I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
consultation
Detailed Answer:
Hello,
Thanks gain for follow up.
I am sorry to inform you that I never used topiramate for PTSD or borderline patients but well experienced with use of topiramate in treatment of bipolar disorder/mania.
Nevertheless I opine that it is quite useful for racing of thoughts, negative feelings, intrusive thoughts and interpersonal sensitivity as per my experience and available data (although limited).
In regard to placing this new agent in treatment regimen I like to decrease dose of Celexa to 10 mg and add Topiramate 25 mg per day at the initiation, provided I was your treating psychiatrist. I would like to raise topiramate to 100-300 mg depending on the response and side effects.
I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Do most people take at night, and does it disturb sleep?
Brief Answer:
Follow up
Detailed Answer:
Hello,
Thanks for follow up.
Most of people prefer to take it at night as it is slightly sedative. However when the dose is increased it can be taken in divided dosages including morning.
Effect on sleep is generally case specific and people experience variety of effects including sedation and activation.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Follow up
Detailed Answer:
Hello,
Thanks for follow up.
Most of people prefer to take it at night as it is slightly sedative. However when the dose is increased it can be taken in divided dosages including morning.
Effect on sleep is generally case specific and people experience variety of effects including sedation and activation.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
my other question, based on recent research, Is about the mixing of lamictal and topomax...
They are both glutamate inhibitors, correct? Lamictal tends to have cognitive effects for me at levels over 150mg (and interferes with my sleep). Would taking topomax at the same time contribute to cognitive effects more than typical?
They are both glutamate inhibitors, correct? Lamictal tends to have cognitive effects for me at levels over 150mg (and interferes with my sleep). Would taking topomax at the same time contribute to cognitive effects more than typical?
Brief Answer:
Yes cognitive effects could be there but not essentially
Detailed Answer:
Hello,
Thanks for reverting back to me.
It is true that cognitive side effects are common with Topiramate and can occur at various dosages. However the cognitive side effects are uncommon below 100 mg of dose and generally dose dependent.
Considering the fact that you have cognitive problems with use of Lamictal chances are high for topiramate for all practical reasons although they are not essential.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Yes cognitive effects could be there but not essentially
Detailed Answer:
Hello,
Thanks for reverting back to me.
It is true that cognitive side effects are common with Topiramate and can occur at various dosages. However the cognitive side effects are uncommon below 100 mg of dose and generally dose dependent.
Considering the fact that you have cognitive problems with use of Lamictal chances are high for topiramate for all practical reasons although they are not essential.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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